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Debate over allowing physical and occupational therapists to be attending providers centers on access to care vs. diagnostic scope
Summary
HB 2243 would permit physical therapists and occupational therapists to serve as attending providers in the workers' compensation medical provider network; PT/OT advocates said it would speed care and return‑to‑work, while physician groups and employer associations warned of diagnostic limits, potential delays from needed referrals, litigation risk, and added administrative costs for the medical provider network.
Committee staff described House Bill 2243, which would allow physical therapists (PTs) and occupational therapists (OTs) to be attending providers under the workers' compensation system. Staff explained attending providers coordinate care, certify time loss, oversee concurrent care, and that adding a provider type would require that provider type to join the L&I medical provider network.
APTA Washington and several PTs/OTs testified in support. Suzanne Michaud, president of APTA Washington, said PTs are a doctorate‑level, direct‑access profession and argued that allowing PTs/OTs to serve as attending providers would improve access, shorten recovery time, and save employers money by accelerating return‑to‑work. Leah Manarelli and other clinicians described delays when referral steps add weeks to care, and said PTs are trained in differential diagnosis and would refer when conditions fall outside their scope.
Opposition came from employer groups and physician organizations. Alex Weihanger (Washington State Medical Association) expressed concern that PTs/OTs might miss non‑musculoskeletal causes and that an initial comprehensive physician evaluation sometimes avoids delays. Rose Gunderson (Washington Retail Association) and Carolyn Logue (Washington Food Industry Association) urged more study and cautioned that expanding attending‑provider status could increase administrative burdens and litigation. James Crandall (Association of Washington Business) echoed concerns about diagnostic scope and downstream delays.
Tammy Fellan (Department of Labor & Industries) told the committee that making PTs/OTs attending providers would require all providers in that type to join the medical provider network and meet network requirements (attestation, malpractice insurance, provider agreement), which could cause some providers to leave the system and create implementation costs. Committee members asked questions about scope of practice, impairment ratings, imaging and referrals, and whether attending PTs/OTs could certify permanent partial disabilities when within scope.
The committee closed the hearing on HB 2243 and adjourned for the day without taking votes on any bills.
